February 10, 2012
As of February 9, 2012, there were 4,118 individuals on AIDS Drug Assistance Program (ADAP) waiting lists in 12 states. This is a 38 percent decrease from the 6,595 individuals on the November 2011 ADAP Watch. Eighteen ADAPs, including 10 with current waiting lists, have instituted additional cost-containment measures since April 1, 2009 (reported as of February 1, 2012). In addition, six ADAPs, including one with current waiting lists, reported they are considering implementing new or additional cost-containment measures by the end of ADAP's current fiscal year (March 31, 2012).
Waiting List Organization: An ADAP waiting list using a first-come, first-served model is structured to place any individual applying to ADAP on the waiting list in order of receipt of a completed enrollment application and eligibility confirmation. Of the 12 states with ADAP waiting lists, seven ADAPs utilize a first-come, first-served model for prioritizing clients to join the active client roll.
An ADAP waiting list using a medical criteria model is structured based on a hierarchical criteria typically established by the state based on recommendations from its ADAP Advisory Committee. Of the 12 states with ADAP waiting lists, five ADAPs utilize a medical criteria model for prioritizing clients to join the active client roll.
Waiting List Client Demographics: African Americans and Hispanics represent 62% (49% and 13%, respectively) of clients on ADAP waiting lists. Combined, Asians, Native Hawaiian/Pacific Islanders, and Alaskan Native/American Indians represent approximately 2% of the total ADAP waiting list population. Multi-racial ADAP clients represent 1% of the total ADAP waiting list population. Non-Hispanic whites comprise 23% of clients on ADAP waiting lists.
Almost three-quarters (74%) of ADAP clients are men. One quarter (25%) of ADAP waiting list clients are women.
Access to Medications: Case management services are being provided to ADAP waiting list clients through ADAP (2 ADAP), Part B (9 ADAPs), contracted agencies (6 ADAPs), and other agencies, including other Parts of Ryan White (5 ADAPs).
For clients on ADAP waiting lists who are currently on or in need of medications, 11 ADAP waiting list states can confirm that ADAP waiting list clients are receiving medications through either pharmaceutical company patient assistance programs (PAPs), Welvista, or other mechanisms available within the state.
Factors Leading to Implementation of Cost-Containment: ADAPs reported the following factors contributing to consideration or implementation of cost containment measures:
|ADAPs With Waiting Lists|
(4,118 Individuals in 12 States*, as of February 9, 2012)
|State||Number of Individuals on ADAP Waiting List||Percent of the Total ADAP Waiting List||Increase/Decrease From Previous Reporting Period||Date Waiting List Began|
|North Carolina||136||3%||-1||January 2010|
|South Carolina||255||6%||0||March 2010|
* As a result of FY2011 ADAP emergency funding, Alabama, Florida, Georgia, Idaho, Louisiana, Montana, North Carolina, Ohio, South Carolina, Utah and Virginia were able to reduce the overall number of individuals on their waiting lists.
** Louisiana has a capped enrollment on their program. This number represents their current unmet need.
|ADAPs With Other Cost-Containment Strategies: Financial Eligibility|
(445 Individuals in 6 States, as of February 1, 2012)
|State||Lowered Financial Eligibility||Disenrolled Clients|
|Arkansas||500% to 200% FPL||99 clients (September 2009)|
|Illinois||500% to 300% FPL||Grandfathered in current clients from 301-500% FPL|
|North Dakota||400% to 300% FPL||Grandfathered in current clients from 301-400% FPL|
|Ohio||500% to 300% FPL||257 clients (July 2010)|
|South Carolina||550% to 300% FPL||Grandfathered in current clients from 301-550% FPL|
|Utah||400% to 250% FPL||89 clients (September 2009)|
Alabama: reduced formulary
Arizona: reduced formulary
Arkansas: reduced formulary
Florida: reduced formulary, transitioned 5,403 clients to Welvista from February 15 to March 31, 2011
Georgia: reduced formulary, implemented medical criteria, participating in the Alternative Method Demonstration Project
Illinois: reduced formulary, instituted monthly expenditure cap ($2,000 per client per month), disenrolled clients not accessing ADAP for 90 days
Kentucky: reduced formulary
Louisiana: discontinued reimbursement of laboratory assays
Nebraska: reduced formulary
North Carolina: reduced formulary
North Dakota: capped enrollment, instituted annual expenditure cap
Ohio: reduced formulary
Puerto Rico: reduced formulary
Utah: reduced formulary
Virginia: reduced formulary, restricted eligibility criteria, transitioned 204 clients onto waiting list
Washington: instituted client cost sharing, reduced formulary, only paying insurance premiums for clients currently on antiretrovirals
Wyoming: capped enrollment, reduced formulary, instituted client cost sharing
Alaska: reduce formulary
Florida: lower financial eligibility
Kentucky: reduce formulary
Montana: reduce formulary
Nebraska: disenroll clients based on medical criteria
Oregon: reduce formulary
Puerto Rico: reduce formulary
Tennessee: establish waiting list
Washington: lower financial eligibility
Wyoming: establish waiting list, lower financial eligibility, institute client cost sharing
California: resulting from state budget crisis
Nebraska: resulting from increased ADAP enrollment
Washington: resulting from state budget decreases and increasing insurance premium costs
Wyoming: resulting from state budget decrease
About ADAP: ADAPs provide life-saving HIV treatments to low income, uninsured, and underinsured individuals living with HIV/AIDS in all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, the Federated States of Micronesia, American Samoa, and the Republic of the Marshall Islands. In addition, some ADAPs provide insurance continuation and Medicare Part D wrap-around services to eligible individuals. Ryan White Part B programs provide necessary medical and support services to low income, uninsured, and underinsured individuals living with HIV/AIDS in all states, territories and associated jurisdictions.